|Dr. Sandhu speaks with symposium attendees|
Overlap of Fibromyalgia and Mood Disturbances and the Role of Mental Health Professionals: presented by Dr. Hartej Sandu, MD, Psychiatrist
The relationship between chronic pain and depression is common. In fact, 50% of people with chronic pain of any kind are also depressed; 80% of those with depression present with physical symptoms. There is a much greater prevalence of depression in all chronic illnesses, but especially in pain conditions like FM. The more severe the pain, the more severe the depression. 30% - 50% of FM patients experience depression and anxiety. In fact, the odds rate of mood disturbances are two times higher in FM patients compared to rheumatoid arthritis.
Dr. Sandu emphasized that fibromyalgia is a real condition, as are mood disturbances. The two conditions interact in a way that makes it more complex for both the patients and the medical providers. He presented three theories on the relationship and treatment of chronic pain and mood disturbances:
No. 1: Depression and stress are a by-product of chronic pain. Treatment is part of somatic (physical) medicine.
No. 2: Somatic symptoms are a manifestation of depression and anxiety. Treatment is primarily a psychiatric problem.
No. 3: Somatic and psychological symptoms are related but different reactions to the same stimulus such as genetic, physiologic and environmental factors. Treatment lies in the overlap of psychiatric and somatic medicine, which is where fibromyalgia lies. (Am I depressed because I'm sick or am I depressed as part of my sickness? My experience has been that the depression is physical, i.e. due to sudden drops in serotonin levels, rather than situational or psychological.)
Neurotransmitters such as serotonin and norepinephrine are the links to dealing with depression, espcially regarding drugs such as the SSRI's, SNRI's. Also, both neurotransmitters are crucial in the descending pain inhibitory pathway, which makes them key chemicals in dealing with both depression and fibromyalgia pain.
Shared Features of FM and Depression:
- strong genetic predisposition
- serotonin transporter gene 5-HTT
- sleep disturbances
- cognitive disturbances
- history of childhood abuse or stress
- catastrophizing - the tendency to have a negative approach when anticipating the future which leads to a state of perceived helplessness. (I have to admit I can be guilty of this!) This has real significance in compounding the difficulties in both conditions. Treating depression does not decrease pain, but reducing catastrophizing does!
Subgroups of FM Patients:
Group 1: Psychological Factors Neutral
- low depression and anxiety
- not very tender
- low catastrophizing
- moderate control over pain
Group 2: Psychological Factors Worsening Symptoms
- high depression and anxiety
- very high catastrophizing
- no control over pain
Group 3: Psychological Factors Improving Symptoms
- low depression and anxiety
- extremely tender
- very low catastrophizing
- high control over pain
It's fruitless to figure out what came first because mood disorders and pain work in unison. The symptoms are real and debilitating. Health care professionals need to work out a treatment approach to address the entire package in a wholistic fashion. Mental health providers should be part of the FM treatment team.
STAY TUNED FOR PART III: OPTIMAL MANAGEMENT OF FM